utilization of maternal health care services among...

Azza M. Hassan, et al Utilization of Maternal Health Care Services Among Women 35

The Egyptian Journal of Community Medicine Vol. 34 No. 4 October 2016

Utilization of Maternal Health Care Services Among Women in EL-

Sheikh Zaid City

Azza M. Hassan*, Nahla F. Abu El-ezz*, Yousra B. Ali **, Aisha M. Abu Alfotouh*

*Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain

Shams University.

** Family care center in El-Sheikh Zaid City; Giza; Ministry Of Health.

Received : October , 2015 accepted : December 2015

Abstract

Background: Maternal health care encompasses the health of women in the

childbearing years, including those in the pre-pregnancy period, those who are

pregnant, and those who are caring for young children. The objective of the maternal

care is prevention of maternal morbidity and mortality which can be achieved through

health care for women before pregnancy, during pregnancy, during and after labor and

inter pregnancy period. Aim of work: To measure the utilization of maternal health

care services among a sample of Egyptian women in EL-Sheikh Zaid city.

Methodology: Descriptive cross- sectional study was done on 385 women who came

to receive service from the EL-Sheikh Zaid primary health care center and were

pregnant within one year duration; those women were interviewed by a questionnaire

asking about their socio-demographic data like the age, work and education, antenatal,

natal and postnatal care services provided to them during the last pregnancy. Results:

Most of mothers (81%) had adequate (four or more) antenatal care (ANC) visits. About

(34.9%) of mothers had their ANC in the private sector. 92.5% of mothers delivered

under supervision of skilled medical team and 45.7% had postpartum medical

counseling. Recommendations: Health center should prepare a health education plan

involving the messages to be given to mothers at each stage of pregnancy and properly

implement this plan. Also, direct attention to the quality of care provided should be

done in order to increase utilization.

Key words: Maternal health care, Utilization, Antenatal care, Natal care, Postnatal care.

Corresponding author: Azza M. Hassan Email : [email protected]

Introduction

Maternal health encompasses the health

of women in the childbearing years,

including those in the pre-pregnancy

period, those who are pregnant, and

those who are caring for young children

(1).The objective of maternal care is

prevention of maternal morbidity and

mortality which can be achieved

through health care for women before

pregnancy, during pregnancy, during

and after labor and inter pregnancy

period (2). Millennium Development

Goals (MDG) are relevant to maternal

health care. Goal five 5 is to reduce

maternal mortality by three-quarters

between 1990 and 2015. This is the goal

towards which the least progress has

been made so far (3). The elements of

maternal health services, including

utilization of: ANC, skilled attendance



at delivery and post natal care are

necessary to achieve improved birth

outcomes measured by: reductions in

neonatal mortality; and reductions in

maternal mortality (4).The goal of ANC

is to have healthy pregnancy, clean and

safe delivery and to give birth to a full

term healthy baby. The Component of

ANC includes the following:

registration and record keeping,

periodic examination, including

laboratory tests, risk detection and

management, immunization, referral as

needed, emotional and psychological

support, health education, nutrition

care, dental care, home visiting and

social care (5). It is recognized that in

addition to a range of interventions

before, during and after pregnancy,

ensuring that all births are attended by a

skilled health worker is a key strategy to

reduce maternal deaths (6).The

proportion of births attended by a

skilled health worker, was selected as a

proxy measure to monitor the progress

towards the MDG 5 target of reducing

maternal mortality. There are sound

medical reasons why governments

should invest in skilled birth attendants,

especially for the time of births. Most

maternal and newborn deaths occur

around the time of delivery or shortly

thereafter. These deaths could be

prevented or managed if women had

access to a skilled attendant with

necessary back-up and support. In fact,

there is a reverse correlation between

the percentage of births attended by

skilled health personnel and maternal

mortality ratio in countries of the

Region. The days and weeks following

childbirth – the postnatal period is a

critical phase in the lives of mothers and

newborn babies. Most maternal and

infant deaths occur during this time.

Yet, this is the most neglected period

for the provision of quality care (7).

Utilization of maternal health services

is related to their availability and socio-

economic, demographic and cultural

factors such as women’s age, education,

employment and autonomy (8,9). This

study was conducted to measure the

utilization of maternal health care

services among a sample of Egyptian

women in EL-Sheikh Zaid city.

Subjects and Methods:

Study setting: EL-Shiekh Zaid primary

health care center located in district 11-

Neighboring 4 EL-Shiekh Zaid city ,

Giza. Serves about 150,000 residents.

Any mother came to receive service

from the center and was pregnant within

one year duration and accepted to

participate in the study was included. A

sample of 385 women was calculated

putting in consideration utilization of

maternal care =50%+5% at 95% C.I

(using Epi Info 7 program). Study

design: Cross- sectional descriptive

study. Study tool: Interviewer-

administered questionnaire asking

about socio-demographic data like the

age, education, husband age, work,

education and number of children,

antenatal care services provided during

the last pregnancy like number of visits,

laboratory investigations and tetanus

toxoid vaccination, As documented in

Ministry Of Health and Population

(MOHP) in physician guidelines

woman is considered having adequate

ANC if she had four or more antenatal

care visits during her pregnancy (5).

The questionnaire was asking also

about details of natal and postnatal care

services provided to the mother during

the last labor. Ethical consideration:

Informed consent was taken from

participants after describing the

objectives of the research and ensuring

confidentiality of data and an approval

was taken from the center



administration. Data management:

Data were revised for any missing data,

coded and introduced to personal

computer, analysis was done using

SPSS (Statistical Package for Social

Sciences) program version 18. To

describe the studied sample,

quantitative data e.g. age were

presented as minimum, maximum,

mean and standard deviation.

Qualitative data e.g. education level,

were presented as count and percentage.

Student t test was used to compare

quantitative data between two groups

and Chi-Square test was used to

compare qualitative data between

different groups. P value < 0.05 was

considered significant

Results:

This study was conducted on 385

women attending the health care center.

Their age was ranging between 16 and

49 years with mean of 27.39 + 6.02

years. Their current socio-demographic

data are shown in table 1 where 95.6%

of them were married, 14.8% illiterate

and 28.1% graduated from University,

40.9% of their husbands had secondary

education and 73.7% work in a private

work, most of women 60.3% were

housewives and about 34.9% had

monthly income ranged from 1000-

2000 LE. Most of the studied women

65.5% were coming to the health center

for vaccination. Regarding obstetric

history of the studied women, number

of previous pregnancies was ranging

between 1and 8 pregnancies, number of

previous abortions was ranging

between zero and four abortions and

number of children was ranging

between zero and six children. As

documented in Ministry Of Health and

Population (MOHP) in physician

guidelines woman is considered having

adequate ANC if she had four or more

ANC visits during her pregnancy (5).

Number of women who had adequate

ANC during their last pregnancy was

312 women representing about 81% of

the studied women (figure 1). When

asking women without history of ANC

about the cause of un-utilization of

services, (56.3%) reported that they

didn’t have health problems during their

last pregnancy and the same percent

reported that the cause is financial

(figure 2). Description of ANC services

provided for women showed that 61.9%

of the studied women started ANC at

their first trimester and 34.9% had their

ANC at the PHC center, general clinical

examination was done for 74.7% and

medical history was taken from 70.2%

of women during their first ANC visit.

Tetanus toxoid vaccination was given

for 79.8% of women and health

education was given for 92.6% (table

2). Regarding health problems during

last pregnancy, 52.9% of women had

health problems. 31.5% of them had

hypertension, (21.2%) had gestational

diabetes, 26.7% had ante-partum

hemorrhage and 41.8% had premature

contractions. When comparing women

with history of adequate ANC and those

without regarding their socio-

demographic data and obstetric history,

there was a statistically significant

difference between them regarding

marital status where percentage of

divorced or widow mothers was lower

among women with history of ANC.

Level of education of women and their

husbands was significantly associated

with history of antenatal care where



percentage of those with high education

level was higher among women with

ANC compared to the other group (p

value < 0 .01). Percentage of women

wand their husbands who had

governmental or private work were

higher among women with history of

ANC and also monthly income (p value

< 0.01) (table 3a). Age of mother,

number of previous pregnancies and

number of children were significantly

higher among women without history of

ANC (p value < 0.01) (table 3b). Natal

care provided for the studied women is

presented in table 4 which shows that

59.7% of women delivered at expected

date, 92.5% delivered under

supervision of skilled medical team,

63.1% had vaginal delivery and 31.4%

had health problems during labor. The

most frequent health problem was

hemorrhage representing about 62.8%

of health problems. When comparing

items of natal care between women with

history of adequate ANC and those

without there was a statistically

significant difference between them

regarding time of labor only where the

percentage of women delivered at

expected date was higher among

women with ANC (p value < 0.01)

(table 5). Regarding postnatal period of

the studied women, 45.7% had medical

counseling during purperium, 50.1%

had family planning counseling by

healthcare provider, 88.8% used family

planning methods, 67.7% breast fed

their infants and 29.4% had health

problems during purperium as wound

infection and breast abscess (table 6).

Regarding relation between history of

adequate ANC and postnatal period, the

percent of women with medical

counseling during purperium was

significantly higher among women

without history of ANC (p value <

0.05). Percentage of women who had

health problems during purperium was

significantly higher among women

without history of ANC (p value < 0.01)

(table 7).

Discussion:

Most of the studied mothers in this

study (81%) had history of adequate

ANC (four or more ANC visits) during

their last pregnancy. This is similar to

the results of Egyptian Demographic

Health Survey (EDHS) done during the

year 2014 which showed that the

percent of mothers who had adequate

ANC during their last pregnancy was

about (83%) (10). Another study done

in Assuit to evaluate ANC services

during the year 2006 and found that

only 37.6% of the studied mothers had

adequate ANC (11). This difference

may be due to the social and cultural

differences between Upper Egypt and

new cities like Sheikh Zayed, higher

education level of mothers, higher

health awareness and also availability

of health services in new cities than in

Upper Egypt. Regarding the time of the

first visit of ANC, (61.9%) of mothers

in this study started ANC in their first

trimester which is different from the

results of previous studies like the

study done in El Omranya, Egypt and

found that more than half of mothers

had their first ANC visit in their second

trimester (12), a study done in north east

Ethiopia found also that 73.2% of the

women made their first ANC visit in

their second trimester of pregnancy (13)

and a third study done in India to

measure utilization of maternal



healthcare services found that only

(40.8%) of the studied mothers had their

first ANC during first trimester (14).

Social and cultural differences and

difference in health awareness may be

the cause of this difference in the time

of start of ANC. In this study, about

(79.8%) of studied mothers had tetanus

toxoid vaccination during their last

pregnancy. This is similar to results of

EDHS 2014 which showed that (75.8%)

of Egyptian mothers had received at

least one tetanus toxoid dose during

their last pregnancy (10), and lower

than results of the study done in India to

measure utilization of maternal

healthcare services during the year 2013

which found that (93.2%) of the studied

mothers had at least one dose of tetanus

toxoid during their last pregnancy (14). Regarding health education messages

during pregnancy, (92.6%) of mothers

in this study had received health

education messages during their ANC

visits. In a study done in Beni-Suef

governorate in Egypt to assess quality

of ANC services, only (20.4%) of the

attendant females had received health

education messages during their ANC

visits (15). Another study done in

United Arab of Emirates to assess

unmet needs for maternal health

services found that only (27.1%) of

mothers had received health education

messages during their ANC (16). A

third study done in Ethiopia found that

only (26.2%) of mothers had a health

education message (13). This difference

between results of our study and the

other three studies may be due to

socioeconomic factors as the three

studies were done in rural areas.

Regarding health problems during

pregnancy the present study found that

(52.9%) of the studied mothers suffered

from health problems during their last

pregnancy and the most common

problem was premature contractions

(41.8%). These results are different

from that reported in a study done in

Qatar to identify maternal

complications and neonatal outcomes

which found that the first two leading

maternal complications are gestational

diabetes (20.8%)) and gestational

hypertension (21.6%) (17).This

difference may be due to the difference

in life style factors between Egypt and

Qatar. The present study showed that

the two most important causes of un-

utilization of ANC services were

financial causes and lack of health

problems (56.3%) for each. This result

is similar to results of the study done in

India to identify determinants of

maternal health care utilization which

found that there is a positive correlation

between household income and

utilization of maternal health care (18).

Also the study done in Ethiopia found

that the primary reasons for not

attending ANC during pregnancy to be

that no illness had occurred during the

recent pregnancy (63.2%) (13). Studies

in many developing countries found

that cost constraints were a barrier in

seeking maternal health services

(19,20,21). Regarding the place of

delivery, the present study found that

most women (92.5%) delivered at

health facilities which is to some extent

similar to results of EDHS 2014 which

found that 87% of mothers delivered at

health facilities (10). Frequency of

caesarian section (CS) among mothers

in the present study was (36.9%) which

is similar to the study done at Al Kasr

Al Aini Hospital which found that the



rate of CS increased from (38.8%) in

2008 to (41.1%) in 2012 (22). Another

study done at Al Mansoura university

hospital found that the rate of CS was

(47.25%) (23). EDHS 2014 reported

that the rate of CS was about (51.8%)

among the studied mothers (10). The

observed high rates of caesarean

sections can be explained by the

changes in obstetric practice and

technology, caesarean section requested

by the mother due to their fear from

vaginal deliveries and labor pain. When

comparing mothers with adequate ANC

and mothers without ANC regarding

socio-demographic factors, the

percentage of divorced or widow

mothers was lower among females with

history of ANC and this may be

attributed to absence of the husband

which leads to increased burden of

responsibilities on the mother and

causes more financial problems. Most

of mothers with history of ANC and

their husbands were highly educated

and had a higher monthly income than

mothers without ANC. These results are

similar to the results of the studies done

in Philippine and Kenya which found

that the higher the educational level and

family income the higher the utilization

of ANC services incomes (24,25). The

present study showed that mothers with

history of adequate ANC were

significantly different from those

without regarding their age and number

of children (those with ANC were

younger and had few number of

children). Women pregnant with their

first child are more cautious about their

pregnancies. Older women on the other

hand, tend to believe that maternal

health care services are not necessary

due to their experiences from previous

pregnancies and therefore have more

confidence about pregnancy and

childbirth and thus may give less

importance obtaining ANC. These

results are similar to results of the study

done in hospital of Assuit university for

evaluation of ANC services and

women's perception which found that

the younger women had more regular

attendance to ANC than the older

women and the majority of regular

attended women (80%) was

primigravida (11).

Conclusion:

Most of studied mothers (81%) received

adequate ANC during their last

pregnancy, were received adequate

ANC, (34.9%) of them had their ANC

in the health center. (92.5%) of studied

mothers delivered in health facilities

under supervision of skilled health

worker and (45.7%) had postpartum

medical counseling.

Recommendations:

Health center should prepare a health

education plan indicating the messages

to be given to mothers at each stage of

pregnancy and properly implement this

plan. Health education messages

should stress on the importance and

elements of ANC using posters and

pamphlets to support verbal messages.

More training is needed to ensure that

providers of maternal health services

comply with the clinical guidelines with

direct attention to the quality of care

provided in order to increase utilization.

References :

1) Makenzi j, Pinger R and Kotecki J

(2005): An introduction to community



Health, 5th Edition, Maternal, infant, a

nd child health, ch 7, (181).

2) Mohammed A. (1998): Study of the

impact of performance review on the

quality of maternal care services at the

Cairo University hospitals Doctorate of

Public Health Thesis, Faculty of

Medicine Cairo University.

3) Simwaka BN, Theobald S, Ameku

dzi YP and Tolhurst R (2005): M

eeting Millennium Development Goals

3 and 5. BMJ 2005; 331:708–9.

4) Tarekegn SM, Lieberman LS

and Giedraitis V (2014): Determinants of maternal health service utilization in

Ethiopia: analysis of the 2011 Ethiopian

Demographic and Health Survey. BMC

Pregnancy Childbirth. 2014 May

7;14:161.

5) MOHP (2007): Egyptian Ministry

of Health and Population "Practice Gui

delines for Family physicians "volume

3"

6) Graham WJ, Bell JS and Bullough

CHW (2001). Can skilled attendance

at delivery reduce maternal mortality in

developing countries? In: Safe mother

hood strategies: a review of the

evidence http://dspace.itg.be/handle/1

0390/2655

7) Mostafa N (2010): Impact accredita

tion on quality of antenatal care service

s in MCH centers Master for public He

alth Thesis, Faculty of Cairo University

. http://erepository.cu.edu.eg/index.php

/cutheses/thesis/view/6125

8) Obermeyer CM and Potter JE (19

91): maternal health care utilization in J

ordan: a study of patterns and determin

ants. Studies In family Planning 22(3)

, 177–187.

9) Stewart K and Sommerfelt AE (1

991): Utilization of maternity care servi

ces: A comparative study using DHS d

ata. Proceedings of the Demographic a

nd Health Surveys World Conference.

Washington, DC. Volume III. pp. 1645

-1668.

10) El-Zanaty F (2015): Egypt

Demographic and Health Survey The

DHS Program 2014 .Cairo, Egypt :

Ministry of Health,El-Zanaty and

Associates.

http://dhsprogram.com/pubs/pdf/PR54/

PR54.pdf

11) Abd Elmohimen HA, Abd-Rabou

RA, Ali HA and Tosson MM (2006): Evaluation of antenatal care services an

d women’s perception in Assiut Univer

sity hospital. Ass. Univ. Bull. Environ.

Res. Vol. 9 No. 1, March 2006

12) Attia P (2013): Assessment of ante

natal care provided through a family he

alth unit, theses of master degree in fam

ily medicine, Cairo University, 2013

13) Fenta M (2007) : Assessment of

factors affecting utilization of antenatal

care services in Ayssaita and Dubti

towns, Afar regional state, north east

Ethiopia. Thesis. pp.37,38.

14) Dabade KJ, Dabade SK and Kha

dilkar HA (2013): A Study on utilizati

on of maternal health care services in

rural area of Aurangabad district, Mah

arashtra, India. Open Access Journal

/www.njcmindia.org Pp: 581,582

15) El-Ziny N (2009): Assessment of

quality of Antenatal care services in Be

ni-Suef governorate. Master for public

Health Thesis, Faculty of Medicine,

Cairo University. http://db4.eulc.edu.eg

/eulc_v5/Libraries/Thesis/BrowseThesi

sPages.aspx?fn=PublicDrawThesis&B

ibID=11391452.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Tarekegn%20SM%5BAuthor%5D&cauthor=true&cauthor_uid=24886529

http://www.ncbi.nlm.nih.gov/pubmed/?term=Lieberman%20LS%5BAuthor%5D&cauthor=true&cauthor_uid=24886529

http://www.ncbi.nlm.nih.gov/pubmed/?term=Giedraitis%20V%5BAuthor%5D&cauthor=true&cauthor_uid=24886529

http://dspace.itg.be/handle/10390/2655

http://dspace.itg.be/handle/10390/2655

http://erepository.cu.edu.eg/index.php/cutheses/thesis/view/6125

http://erepository.cu.edu.eg/index.php/cutheses/thesis/view/6125

http://dhsprogram.com/pubs/pdf/PR54/PR54.pdf

http://dhsprogram.com/pubs/pdf/PR54/PR54.pdf

http://www.njcmindia.org/

http://db4.eulc.edu.eg/eulc_v5/Libraries/Thesis/BrowseThesisPages.aspx?fn=PublicDrawThesis&BibID=11391452






16) Al Hindasi M (2010): Assessment

of unmet needs for maternal health serv

ices in Dibba Al Hissn Health center, S

harjah, United Arab Emirates, Master f

or public Health Thesis, faculty of M

edicine, Cairo University.

17) Bener A, Al-Nufal M, Vachhani P

J, Ali AI, Samson N and Saleh NM (2

013): Maternal complications and neo

natal outcome in Arab women of a fast

developing country, 2013. J Family Co

mmunity Med. 2013 Jan-Apr; 20(1): 27

–34.

18) Shariff A and Singh G (2002): De

terminants of maternal health care utiliz

ation in India: evidence from a recent h

ousehold survey. New Delhi, National

Council of Applied Economic Research

(NCAER). www.ncaer.org

19) Stanton C,Blanc AK,Croft T and

Choi Y (2007): Skilled care at birth in

the developing world Progress to date

and strategies for expanding coverage.

J Biosoc Sci. 2007; 39:109- 120.

20) Houweling T A J, Longmans C, C

ampbell OM and Kunst AE (2007):

Huge poor-rich inequalities in maternit

y care: an international comparative s

tudy of maternity and child care in de

veloping countries. Bull World Health

Organ 2007; 85:745-754

21) Letamo G and Rakgoasi SD (200

3): Factors associated with the non–use

of maternal health services in Botswana

. J Health PopulNutr 2003; 21:40-47.

22) El Khayat W, Adel D, AbdelBar

M and Waly M (2013): Cesarean secti

on rate at a tertiary university hospital i

n Egypt. Kasr Al-Aini Journal of Obste

trics & Gynecology 12/2013; 4(3):66-7

4.

23) Helal A S, Abdel-Hady E, Refaie

E, Warda O, Goda H and Sherief L (

2013): Rising Rates of Caesarean Deliv

ery at Mansoura University Hospital: A

Reason for Concern. Gynecol Obstet 3:

146.

24) Wong EL, Popkin BM, Gullkey D

K and Akin JS (2004): Accessibility q

uality of care and prenatal care use in t

he Philippines. Soc. Sci. Med. 24:927-9

44.

25) Magadi MA, Madise NJ and Rod

rigues RN (2000): Frequency and timi

ng of antenatal care in Kenya: explaini

ng the variations between women of dif

ferent communities. Social Science &

Medicine 51(4), 551–561

http://www.ncbi.nlm.nih.gov/pubmed/?term=Bener%20A%5Bauth%5D

http://www.ncbi.nlm.nih.gov/pubmed/?term=Al-Nufal%20M%5Bauth%5D

http://www.ncbi.nlm.nih.gov/pubmed/?term=Vachhani%20PJ%5Bauth%5D



Table 1: Description of socio-demographic characteristics and

obstetric history of the studied women (total=385):

Socio-demographic characteristics: N. %

Marital status

Married 368 95.6

Divorced 11 2.9

Widow 6 1.6

Level of education

Illiterate 57 14.8

read and write or primary education 67 17.4

secondary or diploma 130 33.8

university graduate 108 28.1

post graduate degree 23 6.0

Husband's level of

education

Illiterate 10 2.6

read and write or primary education 47 12.4

secondary or diploma 155 40.9

university graduate 130 34.3

postgraduate degree 37 9.8

Occupation

governmental work 41 10.6

private work 82 21.3

seasonal work* 30 7.8

Housewife 232 60.3

Husband's

occupation

governmental work 37 9.7

private work 280 73.7

seasonal work* 52 13.7

not working 11 2.9

Monthly income

<500 LE 39 10.2

500-<1000 LE 102 26.6

1000-2000 LE 134 34.9

>2000 LE 109 28.4

*Seasonal work (working only during certain seasons in the year)



Table 2: Description of antenatal care provided for the studied women

(N=312):

Antenatal care: N. %

Start of ANC

first trimester 193 61.9

second trimester 89 28.5

third trimester 30 9.6

Place of ANC

PHC center 109 34.9

general hospital 69 22.1

specialized hospital 58 18.6

private clinic 76 24.4

Number of BP measuring times

every visit 293 93.9

Sometimes 14 4.5

Never 5 1.6

Number of BW measuring times

every visit 244 78.2

Sometimes 66 21.2

Never 2 .6

measuring sugar in blood and

urine every visit

Yes 218 69.9

Sometimes 83 26.6

No 11 3.5

measuring hemoglobin in blood

every visit

Yes 224 71.8

No 5 1.6

Sometimes 83 26.6

Ultrasound for ANC Yes 306 98.1

No 6 1.9

General clinical examination during first ANC visit 233 74.7

Asking about medical history during first ANC visit 219 70.2

TT vaccination 249 79.8

Health education during ANC 289 92.6



Table 3a: Relation between receiving adequate ANC and socio-

demographic characteristics:

Adequate ANC Chi

Square

test

P value No

(N=73)

Yes

(N=312)

N. % N. %

Marital

status

Married 63 86.3 305 97.8 18.39 < 0.001*

Divorced or widow 10 13.7 7 2.2

Level of

education

Illiterate 24 32.9 33 10.6

43.19 < 0.001*

read and write /

primary education 20 27.4 47 15.1

secondary / diploma 23 31.5 107 34.3

university graduate 6 8.2 102 32.7

post graduate degree 0 .0 23 7.4

Husband's

level of

education

Illiterate 10 14.7 0 .0

75.92 < 0.001*

read and write/

primary education 17 25.0 30 9.6

secondary or diploma 32 47.1 123 39.5

university graduate 9 13.2 121 38.9

postgraduate degree 0 .0 37 11.9

Occupation

governmental work 1 1.4 40 12.8

11.96 < 0.001* private work 14 19.2 68 21.8

seasonal work 10 13.7 20 6.4

Housewife 48 65.8 184 59.0

Husband's

occupation

governmental work 5 7.4 32 10.3

56.02 < 0.001* private work 31 45.6 249 79.8

seasonal work 27 39.7 25 8.0

not working 5 7.4 6 1.9

Monthly

income

<500 LE 22 30.6 17 5.4

50.49 < 0.001* 500-<1000 LE 25 34.7 77 24.7

1000-2000 LE 16 22.2 118 37.8

>2000 LE 9 12.5 100 32.1

*Statistically significant at (0.01) level



Table 3b: Relation between receiving adequate ANC and socio-

demographic characteristics (cont.):

Adequate ANC

Student t

test P value

No

(N=73)

Yes

(N=312)

Mean SD Mean SD

Age of Mother (years) 29.15 6.67 26.98 5.79 2.80 0.01*

Number of previous pregnancies 3.85 1.82 2.70 1.40 5.05 < 0.001*

Number of previous abortions .84 .94 .63 .91 1.74 0.08

number of children 3.03 1.44 2.07 1.12 5.32 < 0.001*

*Statistically significant at (0.01) level

Table 4: Description of natal care provided for the studied women:

Natal care: N. %

Time of labor

At the expected date 230 59.7

Before expected date 111 28.8

After expected date 44 11.4

Place of labor

At home 29 7.5

Private clinic 93 24.2

Governmental hospital 186 48.3

Private hospital 77 20.0

Mode of delivery Vaginal 243 63.1

CS 142 36.9

Health problems during

labor

No 264 68.6

Yes 121 31.4

Type of health problem

Hemorrhage 76 62.8

Tears 29 24.0

Uterine prolapsed 2 1.7

Others 14 11.6



Table 5: Relation between receiving adequate ANC and natal care:

Adequate ANC Chi

Square

test

P

value

No

(N=73)

Yes

(N=312)

N. % N. %

Time of labor

at the expected date 32 43.8 198 63.5

10.63 0.01* before expected date 27 37.0 84 26.9

after expected date 14 19.2 30 9.6

place of labor

at home 9 12.3 20 6.4

7.48 0.06 private clinic 14 19.2 79 25.3

governmental hospital 41 56.2 145 46.5

private hospital 9 12.3 68 21.8

Mode of delivery Vaginal 44 60.3 199 63.8

0.31 0.58 CS 29 39.7 113 36.2

Health problems

during labor

Yes 21 28.8 100 32.1 0.30 0.59

No 52 71.2 212 67.9

*Significant at (0.01) level

Table 6: History of postnatal care and description of postnatal period

of the studied women:

Postnatal care: N. %

Medical counseling

during purperium

Yes 176 45.7

No 209 54.3

Family planning

counseling by

healthcare provider

Yes 193 50.1

No 192 49.9

Use of family planning

methods

Yes 342 88.8

No 43 11.2

Type of lactation breast feeding 260 67.7

bottle feeding 124 32.3

Health problems

during purperium

Yes 113 29.4

No 272 70.6



Table 7: Relation between receiving adequate ANC and postnatal

care:

Adequate ANC Chi

Square

test

P value No

(N=73)

Yes

(N=312)

N. % N. %

Medical counseling

during purperium

Yes 42 57.5 134 42.9 5.07 0.02*

No 31 42.5 178 57.1

Family planning

counseling by

healthcare provider

Yes 31 42.5 162 51.9

2.12 0.15 No 42 57.5 150 48.1

Use of family

planning methods

Yes 61 83.6 281 90.1 2.52 .11

No 12 16.4 31 9.9

Type of lactation breast feeding 51 70.8 209 67.0

0.40 0.53 bottle feeding 21 29.2 103 33.0

Health problems

during purperium

Yes 32 43.8 81 26.0 9.12 < 0.01**

No 41 56.2 231 74.0

*Significant at (0.05) level **Significant at (0.01) level



Figure 1: History of adequate antenatal care during last pregnancy

among the studied women

Figure 2: Causes of un-utilization of ANC among the studied women

56.30% 56.30%

31.30%25%

didn't havehealth problem

financial causes long distance toplace of ANC

other causes

utilization of maternal health care services among...

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